European Psychiatry - Volume 41 - April 2017

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S768 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S710–S771
Conclusions The delay before ECT appears on average, four times
longer than recommended by treatment algorithms for the man-
agement of major depressive disorder. This long delay could be
explained by a very heterogeneous access to this treatment in
French territory.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1117
A tribute to Jose M.R. Delgado
(1915–2011): The pioneer of electric
brain-stimulation
L. De Jonge ∗, S. Petrykiv , J. Fennema , P. Michielsen , M. Arts
1 Leonardo Scientific Research Institute, Geriatric Psychiatry, Bergen
op Zoom, The Netherlands
2 University of Groningen, University Medical Center Groningen,
Department of Clinical Pharmacy and Pharmacology, Groningen, The
Netherlands
3 GGZ Friesland, Geriatric Psychiatry, Leeuwarden, The Netherlands
4 GGZWNB, Clinical Psychiatry, Bergen op Zoom, The Netherlands
5 University of Groningen, University Medical Center Groningen,
Department of Old Age Psychiatry, Groningen, The Netherlands
∗ Corresponding author.
Introduction José Manuel Rodriguez Delgado (1915–2011), a
Spanish physiologist, was among the first scientist to perform elec-
tric brain stimulation in both animals and humans. His work on
brain-stimulation research during the 1960s and 1970s was inno-
vative but also controversial.
Objectives To present the scientific papers of Jose Delgado on
psychosurgery.
Aims To review available literature and to show evidence that
Jose Delgado made a significant contribution to the development
of psychosurgery.
Methods A biography and private papers are presented and dis-
cussed followed by a literature review.
Results Delgado showed that with electrical brain stimulation
one could evoke well-organized complex behavior in primates. A
rhesus monkey was stimulated with an electrode implanted inside
the red nucleus, followed by a complex sequence of events. After
stimulation of an area three millimeters from the red nucleus, the
rhesus monkey just yawned. Delgado also investigated the mech-
anisms of aggressive behavior in other animals. Stimulation of the
caudate nucleus by remote control in a fighting bully resulted in
sudden paralysis. In some human patients suffering from depres-
sion, euphoria was induced after stimulation of the septum.
Conclusion Delgado pioneered the brain electrode implantation
in order to electrically stimulate specific brain areas for treatment
epilepsy and of different types of mental illness. He was severely
criticized. His studies, however, paved the way for newmodulation
techniques such as the development of deep brain stimulation.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1118
Manic switch in bipolar patients
treated with electroconvulsive
therapy for treatment-resistant
depression: The experience at the
mood disorder unit of Milan (Italy)
D. Delmonte , S. Brioschi ∗, B. Barbini , R. Zanardi ,
C. Colombo
1 IRCCS San Raffaele-Turro, Division of Neuroscience, Milano, Italy
2 Università Vita-Salute San Raffaele, Division of Neuroscience,
Milano, Italy
∗ Corresponding author.
Introduction Despite appropriate treatment, 30–40% of
depressed patients, both unipolar and bipolar, do not achieve
improvement, with high morbidity and mortality. For bipolar
patients another risk is the switch into mania due to antide-
pressant treatment. The concern about the switch, suggests to
administer antidepressants at lower doses, in combination with
mood stabilizers and second generation anti-psychotics.
Objectives We performed an observational study on a sample of
23 bipolar patients treated with ECT for severe TRD in last 3 years,
in order to evaluate the risk of switch.
Methods Twenty-three bipolar inpatients, undergoing bitem-
poral ECT twice/week, with MECTA spectrum device. Main
demographic and clinical data collected. Hamilton rating scale for
depression (HAM-D). Clinical response defined as 50% reduction of
HAM-D score at the endpoint from baseline; remission as HAM-D
score at the endpoint < 8. Young Mania rating scale (YMRS) weekly
in order to assess switch into mania.
Results Thirteen (56.5%) females, 10 (43.5%) males, mean age
60.1 ±10.3 years. Mean age at onset 35.5 ±13.6 years. Mean num-
ber of episodes: 7.1 ±3.6. Mean duration of current episode:
33.4 ±24.9 weeks. Mean HAM-D basal score: 30.0 ± 5. Each patient
underwent a cycle of ECT (mean No. 6.7 ± 3.3). Pharmacological
treatment was administered upon clinical need. Response rate 87%,
remission rate 43.5%. Three out of 23 (13.04%) patients had tran-
sient hypomanic switch, spontaneous recovery within 7 days after
the last ECT.
Conclusions Our experience confirms that ECT is a powerful
antidepressant, especially in patients with severe long-lasting
depression, refractory to treatment. ECT is also a safe procedure: no
adverse effects were reported. Themanic switch rate is comparable
with antidepressant drugs.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1119
From hypomania to mania after
correcting severe hypoglicemia: A case
report to recall insulin shock therapy
J. Felgueiras ∗, C. Freitas , A.T. Carvalho
Centro Hospitalar do Tamega e Sousa, Departamento de Psiquiatria e
Saúde Mental, Penafiel, Portugal
∗ Corresponding author.
Introduction In the early 20th century, shock therapies devel-
oped worldwide as the most effective means to treat severe mental
illness. In 1927, Manfred Sakel introduced the newly discovered
insulin as a means to treat opioid-addicted patients, by relieving
withdrawal symptoms. After noticing that some psychotic patients
notably recovered from their psychotic symptoms after acciden-
tal insulin comas, he extended this technique to schizophrenic
patients, arguing that up to 70% of his patients improved with
this therapy. Insulin shock therapy soon spread all-over the world
and became one of the most important treatments for severe
mental illness. Regardless of the high-rate complications, insulin
shock therapy only declined after the introduction of anti-psychotic
drugs.
Objective Description of a clinical case.
Methods Non-systematic review of literature and case report.
Results A 70-year-old female with type-1 bipolar disorder and
type-2 diabetes was referred to a psychiatry emergency depart-
ment (ED) for 2-week behavioral disorder, featuring restlessness,
agitation, insomnia, verbiage and persecutory delusions. In the ED,
she presented calm, cooperating, with a subtle humor elation and
slight disinhibition. The speech was somewhat confusing, but with